Specialist Paediatric Dietetic Services, referral guidelines for GPs

• Pre-school children

• Initial assessment and first-line advice should be provided by the Health Visitor or Family Nurse.
• If there is no underlying medical cause, the child is not under the care of a Paediatrician, and there is no open duty of care with Dietetics, they should be referred to the Growth and Nutrition Advisory Service (GNAS) for further assessment and advice, in line with the NHS GGC Weight Faltering Pathway for pre-school children.
• Health Visitors refer to GNAS via EMIS. GPs cannot refer to GNAS directly.

• Infants and children under 5 with an underlying medical cause
• If the child is known to a Paediatrician, they should be referred to Specialist Paediatric Dietetic Services.
• Infants under 12 months will be triaged as urgent, while children over 12 months will be triaged as routine.

• Children aged 5-16 years
• Those with growth faltering not known to a Paediatrician should be referred to the local community dietetic service for assessment and first-line dietary advice.
• If Oral Nutritional Supplements (ONS) are required, community dietitians will transfer care to Specialist Paediatric Dietetic Services for ongoing management.

• Young people over 16 years requiring ONS
• Those with weight faltering who require ONS, and who are not known to a Paediatrician or are transitioning to adult services should be referred to their local community dietetic team. The community dietitians can liaise with the paediatric dietitians for advice if necessary.

Cow’s milk allergy

• Infants under 1 year
• For suspected non-IgE CMA, follow the NHSGGC CMPA Pathway.
• For suspected IgE-mediated CMA, refer to the Paediatric Allergy Service.
• Infants with confirmed IgE or non-IgE CMA should be referred to Specialist Paediatric Dietetic Services. They will be triaged to either a clinic appointment or group education session, depending on clinical and social history.

• Children over 1 year
• For confirmed non-IgE CMA, refer to the local Community Dietetic Service
• For confirmed IgE-mediated CMA, refer to Specialist Paediatric Dietetic Services and the allergy service.

Single Food Allergies or Intolerances

• Specialist Paediatric Dietetic Services do not accept referrals for single food allergies or intolerances (such as egg or nut), unless there are concerns regarding nutritional impact.
• If the reaction is suspected to be IgE-mediated, refer to the Paediatric Allergy Service.
• Children over 1 year with a single confirmed food allergy or food intolerance and no nutritional concerns can be referred to their local community dietetic service for dietary assessment

Multiple Food Allergies

• Children with multiple confirmed food allergies should be referred to Specialist Paediatric Dietetic Services for dietary assessment and advice

• The initial assessment and advice should be carried out by the Health Visitor or Family Nurse.
• If the child is experiencing weight faltering, please follow the NHS GGC Weight Faltering Pathway.
• If there is no improvement, consider referring to the Growth and Nutrition Advisory Service (GNAS).
• If concerns persist, further referrals may be made to Speech and Language Therapy and/or General Paediatrics.
• Referrals for children with delayed weaning will be accepted by the Specialist Paediatric Dietetic Services only if the child is already under the care of a Neonatologist or Consultant Paediatrician.

• Advice can be sought from the Growth and Nutrition Advisory Service (GNAS)
• Specialist Paediatric Dietetic Services do not accept GP referrals for children on restricted diets due to parental choice or lifestyle reasons (e.g. vegan/vegetarian diets, or dietary exclusions based on perceived food reactions such as those linked to ADHD or presumed gastrointestinal symptoms).
• Referrals will only be considered if there is evidence of growth faltering or other significant medical, nutritional, or social concerns, and the child is under the care of a Consultant Paediatrician.
• Children over 1 year of age who are following restricted diets can be referred to their local community dietetic service for general dietary assessment and advice.

• First-line healthy eating advice for infants and children under 5 years (e.g. infant feeding, weaning, fussy eating, and constipation) should be provided by the Health Visitor. Health visitors can seek advice from the Growth and Nutrition Advisory Service.
  
  
• Families of children aged 0-12 years can be referred or self-refer to the Henry Healthy Families Programme.
• If there is no improvement following this, children over 1 year of age may be referred to their local community dietetic service.
  
  
• Iron deficiency

• Children with confirmed iron deficiency should be referred to community dietetics.
• If iron deficiency is suspected, consider arranging blood tests if possible, or refer to General Paediatrics for further investigation.

• Support for Families with Children Aged 0–12 Years
• The HENRY programme supports families with children aged 0–12 years by promoting healthier eating and lifestyle habits through a whole-family approach.
• The programme includes a range of support including workshops, resources and online help.
• Children can be referred by a health professional or families can self-refer.
  
  
• Support for Young People Aged 12–18 Years
• For children and young people aged 12–18 years with a BMI over 25 kg/m², referrals can be made to the local ‘Weigh to Go’ programme. Self-referral is also available.

• Selective Eating (e.g., ARFID, Autism)

• Children who are open to CAMHS should be referred to the CAMHS Dietetic Service.

• Children aged 0-16 years who are not open to CAMHS who have a restrictive dietary intake, weight faltering and / or nutritional deficiencies can be referred to the Specialist Paediatric Dietetic Service.

• Children under 2 years of age with a restrictive dietary intake, no growth faltering and no confirmed nutritional deficiencies can be referred to the Specialist Paediatric Dietetic Service.

• Children over 2 years of age not currently open to CAMHS with a restrictive dietary intake, no growth faltering and no confirmed multiple nutritional deficiencies can be referred to their local Community Dietetic Service for dietary assessment.

• Eating Disorders

• All children and young people with suspected or confirmed eating disorders should be referred to the local CAMHS Team for assessment.

• Community Dietetic Services and Specialist Paediatric Dietetic Services do not accept referrals for children with suspected or diagnosed eating disorders.

Infants and children who require home enteral tube feeding or have a medical condition requiring a specialist diet (e.g. diabetes, coeliac disease, ketogenic diet) will be managed by a named Specialist Paediatric Dietitian based at the Royal Hospital for Children, Inverclyde Royal Hospital, or Vale of Leven Hospital.